Physical Activity on Prescription (PAP), in patients with metabolic risk factors. A 6-month follow-up study in primary health care

Abstract

There is strong evidence that inadequate physical activity (PA) leads to an increased risk of lifestyle-related diseases and premature mortality. Physical activity on prescription (PAP) is a method to increase the level of PA of patients in primary care, but needs further evaluation. The aim of this observational study was to explore the association between PAP-treatment and the PA level of patients with metabolic risk factors and the relationship between changes in the PA level and health outcomes at the 6 month follow-up. This study included 444 patients in primary care, aged 27–85 years (56% females), who were physically inactive with at least one component of metabolic syndrome. The PAP-treatment model included: individualized dialogue concerning PA, prescribed PA, and a structured follow-up. A total of 368 patients (83%) completed the 6 months of follow-up. Of these patients, 73% increased their PA level and 42% moved from an inadequate PA level to sufficient, according to public health recommendations. There were significant improvements (p≤ 0.05) in the following metabolic risk factors: body mass index, waist circumference, systolic blood pressure, fasting plasma glucose, cholesterol, and low density lipoprotein. There were also significant improvements regarding health-related quality of life, assessed by the Short Form 36, in: general health, vitality, social function, mental health, role limitation-physical/emotional, mental component summary, and physical component summary. Regression analysis showed a significant association between changes in the PA level and health outcomes. During the first 6-month period, the caregiver provided PAP support 1–2 times. This study indicates that an individual-based model of PAP-treatment has the potential to change people’s PA behavior with improved metabolic risk factors and self-reported quality of life at the 6 month follow-up. Thus, PAP seems to be feasible in a clinical primary care practice, with minimum effort from healthcare professionals.

Exercise‐based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation – A randomized controlled study

“…Although PAP has been associated with positive effects on metabolic risk factors, HR-QoL, and self-reported physical activity, 6,23 older patients might have difficulties achieving the recommended levels of physical activity. 24 Orrow et al 25 found that physical activity counseling in primary care did not increase physical fitness (assessed as VO 2max ), which is in line with our results.…”

“…Positive effects of physical activity on prescription (PAP) have been reported on metabolic risk factors, HR-QoL, and self-reported physical activity. 6 In the last decade, PAP, together with motivational interviewing, has therefore been used by health professionals to counteract a low physical activity level, and to reduce the risk of cardiovascular morbidity and premature mortality. 7 PAP does, however not include any supervised exercise and is often prescribed without prior assessment of physical fitness in contrast to PTX.…”

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

“…The prescription programme in Sweden has shown impressive relative adherence and impact with a 17% dropout and significant improvement in PA for 73% of the cohort at 1 year follow-up. 30 Data from the Netherlands also indicate sustained adherence. 31 Yet data across other European countries show variance in scheme adherence and PA changes with most of the literature suggesting that that the UK has a particularly variable adherence level.…”

What is the time cost of exercise? Cost of time spent on exercise in a primary health care intervention to increase physical activity

“…Dropout was related to sex (more female), musculoskeletal disorders, diastolic blood pressure and quality of life. No significant differences between followed up and dropouts were seen for age, socioeconomic factors, tobacco, and all other risk factors/diseases [13].…”

“…The study population consisted of 444 patients from 15 primary health care centers in Gothenburg, Sweden, included during 2010-2014. The study design and medical results are presented in detail elsewhere [13]. The inclusion criteria were: being physically inactive, having at least one component of the metabolic syndrome present, receiving PAP treatment, and understanding the Swedish language.…”